Tonites the first nite with new stuff

[jnk]

If I had to start using a FFM, I'm sure I would need to spend a few weeks getting used to it.

Step one, in my opinion, if it was me, would be nothing but water within four hours of bed. I understand that, with time, some people can be cured of their aerophagia problems that way alone.

It can be a delicate dance getting the right balance of bilevel AND the right balance of auto-ing with an autobilevel being used to fight SDB and aerophagia at the same time, I hear. But there may very well be a sweet spot to be found with a little time, patience, and perseverence.

Easy for me to say. I know I'm just a relative newbie throwing around ideas.

I DO know, though, that if there is an answer to be found with it, you will, with your years of experience, find that answer. The questions I would be asking myself are: What is causing the belly of air? Is it the PS? Is it the EPAP? Is it the "auto-ing," the changing the pressures around all night? Or is it consuming anything other than water within four hours of bed? Experimentation will answer those questions, I'm sure.

We're all cheering for you on this, Jeff. We may all learn from the answers you find for you.

[JeffH]

If I had to start using a FFM, I'm sure I would need to spend a few weeks getting used to it.

Step one, in my opinion, if it was me, would be nothing but water within four hours of bed. I understand that, with time, some people can be cured of their aerophagia problems that way alone.

It can be a delicate dance getting the right balance of bilevel AND the right balance of auto-ing with an autobilevel being used to fight SDB and aerophagia at the same time, I hear. But there may very well be a sweet spot to be found with a little time, patience, and perseverence.

Easy for me to say. I know I'm just a relative newbie throwing around ideas.

I DO know, though, that if there is an answer to be found with it, you will, with your years of experience, find that answer. The questions I would be asking myself are: What is causing the belly of air? Is it the PS? Is it the EPAP? Is it the "auto-ing," the changing the pressures around all night? Or is it consuming anything other than water within four hours of bed? Experimentation will answer those questions, I'm sure.

We're all cheering for you on this, Jeff. We may all learn from the answers you find for you.

Thanks JNK....appreciate the kind words.

Talked to the doc's office this morning and they told me to change the machine to 8epap 14ipap, and 3ps. I'm used to a cpap pressure of 12 so I'm a little uncomfortable with these settings but I'll try them.

I almost never eat anything after dinner, so that isn't the problem. I did learn about a week ago that I have an ulcer but they are treating that with antibiotics.

What I seem to be having the most trouble with is

1. Mask leaks

2. I tend to quit breathing when I'm falling asleep. The IPAP air wakes me up and I'm back at the start again.

JeffH

[robysue]

JeffH,

Sorry to hear the first night with the bi-level was so rough.

It would help the trouble shooting if we knew: What your bi-level settings are and whether you are running in auto mode. You mentioned finally getting to sleep after 4:30 "by setting the machine up straight cpap @ 12.4" but you never told us what the bi-level settings that were creating the problems at the beginning of the night were.

Why were you switched to bi-level in the first place by the way? Aerophagia issues or something else? As -SWS states, some people's aerophagia gets worse on bi-level and others' gets better. [My aerophagia got much better on BiPAP for example.]

And I'm not above giving you the same advice you heard as a newbie CPAP user: It takes time and perseverance and some hard work and a willingness to tweak things before you'll be completely comfortable. But it will get better in time.

Note to -SWS: You write:

P.S. You might have aerophagia problems with BiLevel as well... But don't assume that. Aerophagia can supposedly be affected via vagal stimulation... And a BiLevel machine supposedly stimulates the vagal nerve with BiLevel pressure pulsing.... BiLevel can conceivably help or worsen your aerophagia, depending on your aerophagia's underlying etiology.

Care to elaborate or provide a useful link on what you mean by "vagal nerve stimulation" and its connection to aerophagia?

[rested gal]

JeffH, has a doctor scoped your esophagus?
Maybe the upper and/or lower esophageal sphincter muscles have been damaged or weakened over the years. Untreated or undertreated acid reflux disease can damage them. There is such a thing as Silent GERD.

CPAP air can get shoved past a damaged weak esophageal sphincter and enter the stomach. Aerophagia can be very painful, or...just annoying. When painful, it sure can interfere with being able to do any kind of positive air pressure therapy.

[jnk]

Talked to the doc's office this morning and they told me to change the machine to 8epap 14ipap, and 3ps. I'm used to a cpap pressure of 12 so I'm a little uncomfortable with these settings but I'll try them.

If you are in VAuto mode, those should be Min EPAP and Max IPAP, right? If so, putting in that 3 PS and having an 8 Min EPAP means you will start off the night at 11 cm (breathe-in) over 8 cm (breathe-out), or 11/8. If the machine senses obstruction, it will be able to raise pressures up to 14/11. So the pressures may not be that far off from what you are used to.

I almost never eat anything after dinner, so that isn't the problem. I did learn about a week ago that I have an ulcer but they are treating that with antibiotics.

If I understand Dr. Park correctly, he seems to feel that even drinking anything other than water can be problematic. Even a cup of tea or a sip or two of diet soda. Nothing but water. Something about the stimulation of the stomach and the lower esophageal sphincter (LES) or something.

I tend to quit breathing when I'm falling asleep. The IPAP air wakes me up and I'm back at the start again.

For me, when I'm having trouble with the waking-up-just-as-I'm-falling-asleep thing, the solution is to raise my minimum EPAP so that my airway is kept sufficiently open during "settling" (their word for ramp, basically). For some people, keeping the initial pressures low helps them fall asleep. But for those of us with serious upper-airway-closure issues, we need enough pressure as we fall asleep or we will wake ourselves up.

If it is the sudden increase in pressure that wakes you up as you fall asleep, the answer may be increasing the "settling" time so that no increase in pressure occurs as you fall asleep.

So if it was me, I would try hard to figure out which one of those was the one that was happening so I could figure out whether increasing Min EPAP or increasing the amount of time for "settling" was the answer in my particular case. Thing is, since it is happening as we fall asleep, sometimes it isn't easy to tell which one is happening, so we have to try one for a few nights then undo that setting and try the other for a few nights.

These are just ideas, Jeff. I know you have things well in hand and will keep plugging away at it.

[JeffH]

Talked to the doc's office this morning and they told me to change the machine to 8epap 14ipap, and 3ps. I'm used to a cpap pressure of 12 so I'm a little uncomfortable with these settings but I'll try them.

If you are in VAuto mode, those should be Min EPAP and Max IPAP, right? If so, putting in that 3 PS and having an 8 Min EPAP means you will start off the night at 11 cm (breathe-in) over 8 cm (breathe-out), or 11/8. If the machine senses obstruction, it will be able to raise pressures up to 14/11. So the pressures may not be that far off from what you are used to.

I almost never eat anything after dinner, so that isn't the problem. I did learn about a week ago that I have an ulcer but they are treating that with antibiotics.

That's pretty much what I do. There are some meds I take later in the evening, but I only use water to wash them down.

If I understand Dr. Park correctly, he seems to feel that even drinking anything other than water can be problematic. Even a cup of tea or a sip or two of diet soda. Nothing but water. Something about the stimulation of the stomach and the lower esophageal sphincter (LES) or something.

I tend to quit breathing when I'm falling asleep. The IPAP air wakes me up and I'm back at the start again.

For me, when I'm having trouble with the waking-up-just-as-I'm-falling-asleep thing, the solution is to raise my minimum EPAP so that my airway is kept sufficiently open during "settling" (their word for ramp, basically). For some people, keeping the initial pressures low helps them fall asleep. But for those of us with serious upper-airway-closure issues, we need enough pressure as we fall asleep or we will wake ourselves up.

That happened even during the settling stage, I think

If it is the sudden increase in pressure that wakes you up as you fall asleep, the answer may be increasing the "settling" time so that no increase in pressure occurs as you fall asleep.

So if it was me, I would try hard to figure out which one of those was the one that was happening so I could figure out whether increasing Min EPAP or increasing the amount of time for "settling" was the answer in my particular case. Thing is, since it is happening as we fall asleep, sometimes it isn't easy to tell which one is happening, so we have to try one for a few nights then undo that setting and try the other for a few nights.

These are just ideas, Jeff. I know you have things well in hand and will keep plugging away at it.

[JeffH]

JeffH,

Sorry to hear the first night with the bi-level was so rough.

It would help the trouble shooting if we knew: What your bi-level settings are and whether you are running in auto mode. You mentioned finally getting to sleep after 4:30 "by setting the machine up straight cpap @ 12.4" but you never told us what the bi-level settings that were creating the problems at the beginning of the night were.

Why were you switched to bi-level in the first place by the way? Aerophagia issues or something else? As -SWS states, some people's aerophagia gets worse on bi-level and others' gets better. [My aerophagia got much better on BiPAP for example.]

And I'm not above giving you the same advice you heard as a newbie CPAP user: It takes time and perseverance and some hard work and a willingness to tweak things before you'll be completely comfortable. But it will get better in time.

Note to -SWS: You write:

P.S. You might have aerophagia problems with BiLevel as well... But don't assume that. Aerophagia can supposedly be affected via vagal stimulation... And a BiLevel machine supposedly stimulates the vagal nerve with BiLevel pressure pulsing.... BiLevel can conceivably help or worsen your aerophagia, depending on your aerophagia's underlying etiology.

Care to elaborate or provide a useful link on what you mean by "vagal nerve stimulation" and its connection to aerophagia?

Here is the prescription.

Max IPAP: 18
Min EPAP: 10
PS: 4
TiMax: 2.5
TiMin: 0.3
Trigger / Exhale: Med.
Cycle: High

BTW, to answer JNK's question, yes, it's running in VAUTO mode.

[jnk]

There are some meds I take later in the evening, but I only use water to wash them down.

It may be worth asking your doc if you can take that last dose earlier. If not, fine. But it doesn't hurt to ask.

Some meds can even relax the LES (a problem for PAP users) too, so using a different, but similar, med may end up helping one day.

So there are plenty of things to try, little by little, over time, in cooperation with your doc, to get at the root of things. That is a reason for hope, not frustration, as I see it. The problem for me, personally, when I find myself in such situations, can be having the patience to try one little thing at a time instead of changing everything all at once.

I tend to quit breathing when I'm falling asleep. . . .That happened even during the settling stage, I think

If I woke myself during settling with a snore or a snort or any feeling of blocked breathing, I would bump my Min EPAP up a notch, myself. Sometimes 0.2 cm higher can make all the difference in the world.

[Wulfman]

Hey.....look at it this way......at least we won't be giving you those typical forum responses to "newbies"......
"Hang in there"......"You'll get used to it"......."Keep trying"........etc., etc.

Curious why we shouldn't give Jeff that advice... since he's not yet accustomed to the "feel" of BiLevel?

OutaSync was no newbie when she switched to ASV's BiLevel either. And she had a hell of a time just learning to sleep with her ASV machine's BiLevel pulsing. But now that she's used to it, she claims that machine gives her the best AHI and most comfortable sleep she's had...

Jeff, give yourself some time to acclimate to BiLevel... before prematurely casting judgment. And good luck!

P.S. You might have aerophagia problems with BiLevel as well... But don't assume that. Aerophagia can supposedly be affected via vagal stimulation... And a BiLevel machine supposedly stimulates the vagal nerve with BiLevel pressure pulsing.... BiLevel can conceivably help or worsen your aerophagia, depending on your aerophagia's underlying etiology.

Maybe I was assuming too much, but for one thing, he's been at this alot longer than many of us and shouldn't need to be told that stuff.

Oh, well........Hang in there, Jeff. You'll get used to it. Keep trying.


Den

[jnk]

Hang in there, Jeff. You'll get used to it. Keep trying.

Does that go for me too, Den? or just JeffH?

Because, frankly, I need to hear that once in a while, myself.

Don't we all?

[Wulfman]

Hang in there, Jeff. You'll get used to it. Keep trying.

Does that go for me too, Den? or just JeffH?

Because, frankly, I need to hear that once in a while, myself.

Don't we all?

It applies to EVERYBODY!


Den

[jnk]

Hang in there, Jeff. You'll get used to it. Keep trying.

Does that go for me too, Den? or just JeffH?

Because, frankly, I need to hear that once in a while, myself.

Don't we all?

It applies to EVERYBODY!


Den

Thanks.

Hang in there, Den!

[Wulfman]

Hang in there, Jeff. You'll get used to it. Keep trying.

Does that go for me too, Den? or just JeffH?

Because, frankly, I need to hear that once in a while, myself.

Don't we all?

It applies to EVERYBODY!


Den

Thanks.

Hang in there, Den!

Thanks! I needed that.


Den

[-SWS]

As -SWS states, some people's aerophagia gets worse on bi-level and others' gets better. [My aerophagia got much better on BiPAP for example.]

Note to -SWS: You write:

P.S. You might have aerophagia problems with BiLevel as well... But don't assume that. Aerophagia can supposedly be affected via vagal stimulation... And a BiLevel machine supposedly stimulates the vagal nerve with BiLevel pressure pulsing.... BiLevel can conceivably help or worsen your aerophagia, depending on your aerophagia's underlying etiology.

Care to elaborate or provide a useful link on what you mean by "vagal nerve stimulation" and its connection to aerophagia?

Robysue... The Resmed Adapt SV's original marketing sheet was the first time I had ever heard that PAP therapy of any kind performs pressure-based vagal stimulation. Resmed soon dropped that as a selling point. I suspect they dropped that claim because medicine still understands next-to-nothing about the relationship between pressure-based vagal stimulation and LES dysfunction/mitigation regarding aerophagia or GERD--- or pressure-based vagal stimulation influencing certain cardiopulmonary dynamics more germane to CSA/CompSAS.

If vagal stimulation directly influenced your aerophagia, consider the possibility that the various patterns of vagal stimulation from one xPAP modality to the next conceivably subscribed to one or both of these two scenarios: 1) some xPAP vagal-stimulation patterns might have exerted LES dyscontrol as iatrogenic, and/or 2) some xPAP vagal-stimulation patterns might have exerted LES control as mitigating.

Some related links:

http://www.dent.niigata-u.ac.jp/dysphag ... /kajii.pdf
(page 600 discusses that air pressure as vagal stimuli can induce reflexive pharyngeal swallowing)

http://www.google.com/search?q=enteric+ ... ee79d1fe4a
(interesting interrelatedness)

http://www.google.com/search?q=enteric+ ... ee79d1fe4a
(your other brain---specifically the one that doesn't do math)

http://www.google.com/search?q=vagal+af ... =firefox-a
(vagal afferent-mediated lower esophageal sphincter relaxation)

[Catnapper]

Hi Jeff

Sleep is so touchy when one makes changes. I am sorry to hear of your troubles.

Hope things improve quickly. I know you will keep trying to find the answers, and I am also certain of your future success!

Catnapper - Joanie